Some surprising new roles in store for access staff

Major shift is occurring

The patient access world is seeing nothing less than a sea change in its roles and responsibilities, according to Pam Carlisle, CHAM, corporate director of patient access services at OhioHealth in Dublin.

"The patient access areas are seeing a shift in the functionality and roles they hold," says Carlisle. "The access world has changed to support both regulatory requirements and financial success within each entity."

Patient access areas now are expanding roles to promote career growth, reward high-performing staff, and streamline processes to gain efficiencies, says Carlisle. Here are some new positions Carlisle sees being created in the access area:

• Senior access specialists.

This role includes providing onsite training, educating staff on new processes, and auditing of current processes to ensure compliance, says Carlisle.

• Data analyst roles.

These individuals specialize in collecting and trending information to assist patient access leaders on the training programs needed for their teams, says Carlisle, as well as areas where processes need to be re-designed or improved.

"They also demonstrate success of newly implemented processes," adds Carlisle. "This position has become more solid than ever, to really help the front end focus in on accuracy, data integrity, and compliance information."

• Training and education coordinators.

"Previously on the down trend due to budget cuts, development of online training programs and system training programs with competency tests are once again emerging," says Carlisle.

Carlisle adds that tracking and trending compliance education and staff competency is "a must, to ensure we have well-trained staff on the front lines to enhance the revenue for our hospitals."

• Handling medical necessity and precertification needs in the pre-services area.

"We have not experienced this yet, but many hospitals across the country are adding a nurse in this role. The more insurance companies add on administrative requirements, the more this addition may grow to other entities," says Carlisle.

The role includes validating medical diagnosis codes and communicating with physicians, notes Carlisle. "Peer-to-peer reviews for authorizations are helping many hospitals secure payment for their services," she adds.

• Cashiers/collectors.

The cashier/collector position reviews all open accounts with patients, establishes payment plans, and secures information needed for a charity application at the time the patient is present. "There is a movement toward re-engineering the cashier office functions to more than just taking one payment from a patient into more of a collector," says Carlisle.

Patient access staff have just a few minutes to engage in a dialogue to confirm who patients are, why they are here, how much they owe, and educate them on all regulatory information, says Carlisle. "This must all be done within three to five minutes, so as not to delay care," she adds. Here are four newly expanded responsibilities for access that she sees:

1. Patient identity.

"The information the staff on the front line collect is all subject to what is presented by the patient," says Carlisle. "Confirming those red rules is a necessity, not only for patient safety, but to protect the identity of your patient."

Some patients become frustrated with the amount of data that staff must verify, notes Carlisle. "We have to explain that our process is for their benefit," she says. "We collect very personal and financial information that, if compromised, would be damaging to our patients."

2. Privacy.

"Space allocation in all hospitals is a challenge," says Carlisle. "We have to maximize our clinical space to be able to provide great care to our patients. At the same time, we cannot jeopardize or minimize the space design for the administrative functions."

Carlisle says that, too often, patient access areas are the last to be included in the design phase. "However, with the growing acceptance and understanding of this profession, we have seen a trend of putting them at the table during initial design discussions," she says.

3. Point-of-service collections.

Despite a trend of rising deductibles and higher out-of-pocket responsibility, Carlisle says that increasing numbers of unemployed and underinsured patients is complicating the collection efforts for many hospitals. "We all know point-of-service collections are critical to the revenue cycle in reducing A/R and bad debt," she says.

Patient access staff are "struggling today to balance collection and customer service efforts with the patients they serve," says Carlisle. Staff can identify the amount owed, and ask for that amount at the point of service, but cannot delay care, she explains.

You should look at point-of-service collections as part of your service to the patient, says Carlisle. This includes educating them on their out-of-pocket responsibility, giving them options if they can't pay, and working with them to satisfy their financial obligation, she says.

"We would like patients to focus on getting better quicker. We want to relieve that financial stress by taking care of all administrative details prior to their service," says Carlisle. "A changing economy has made this balance difficult to manage."

4. Staff development.

Carlisle says that in order to meet all of these challenges, patient access departments must give staff the tools they need. This includes education programs "as often as staff need them," she says, and process designs that are efficient for their work flow.

"They have to service all of their patients quickly and accurately. We have to build an environment for their success," says Carlisle. "This will result in better satisfied employees, which leads to greater customer service for our patients."

[For more information, contact:

Pam Carlisle, CHAM, Corporate Director, Patient Access Services, OhioHealth, Dublin, OH. Phone: (614) 544-6099. E-mail: PCARLISL@OhioHealth.com.]